Yes, Quiet Borderline Personality Disorder Is a Real Condition

Borderline personality disorder (BPD) is a mental health condition that’s characterized by unstable relationships, intense emotional instability, and poor sense of self. Some people with the condition, though, have less obvious symptoms — a subset of the condition known as “quiet borderline personality disorder” (or “quiet BPD”).

It’s important to note that quiet BPD is not an official or formal diagnosis, says Kathleen Douglass, a licensed clinical professional counselor with Charlie Health. Rather, it’s conversationally and informally used as a way to recognize a unique presentation of borderline personality disorder. Read on to learn more about what quiet BPD is, the signs and symptoms of quiet BPD, treatment, and more.

What is quiet borderline personality disorder?

Quiet BPD is essentially a less obvious presentation of typical BPD. Douglass says you can look at it as visible BPD versus invisible BPD. “With traditional borderline personality disorder, a person’s feelings are all on the outside. They can be outwardly unstable, very angry, wear their emotions on their sleeve, and take things out on people around them,” says Douglass. “In quiet BPD, those emotions are internalized instead of externalized.” 

A person with quiet BPD may still have the classic BPD symptoms — mood swings lasting hours or days and relationship struggles due to an intense fear of abandonment — but they just don’t wear their emotion on their sleeve so much. The symptoms are just as intense and troubling, but they tend to hold it all in and usually take it out on themselves instead of others. Quiet BPD is often very guilt and shame-based internally, Douglass says. 

The internalized presentation of quiet BPD makes it much more difficult for an outsider to know that someone is grappling with the mental health condition. It’s estimated that 1.4% of adults and 3% of teens in the general population have BPD. There is no data for what percentage of these people have “quiet BPD.”

Signs and symptoms of quiet borderline personality disorder

The list below relates to both BPD symptoms and quiet BPD symptoms since both are based on the same diagnostic criteria. When considering quiet BPD symptoms, remember these symptoms are typically shown and felt more inwardly rather than outwardly. 

• Intense, difficult-to-regulate emotions
• Fear of abandonment
• Unstable and intense relationships
• Engaging in impulsive behaviors
• Intense mood swings (a strong emotion may last hours or days)
• Self-harming
• Feeling empty 
• Unstable or poor sense of self
• Feeling like your opinions, goals, and values always shift
• Anger issues
• Dissociation (feeling detached from yourself or your surroundings)
• Suicidal thoughts 

If you’re experiencing suicidal thoughts or are in danger of harming yourself, this is a mental health emergency. Contact The National Suicide Prevention Lifeline 24/7 by calling or texting 988.

What are the risk factors for developing quiet borderline personality disorder?

Currently, there isn’t research about what causes quiet BPD specifically, but the following are potential risk factors and causes for someone developing BPD in general.

Genetics

There is a genetic component to many mental health conditions, including BPD. BPD may run in families –– meaning if you have an immediate family member with a mental health disorder like BPD, you are more likely to have it, also. 

Trauma

Researchers have found that people who have experienced trauma, particularly childhood trauma, are more likely to develop BPD. Examples include verbal, physical, or sexual abuse and neglect. Growing up in poverty is also a recognized risk factor for BPD. 

Brain differences

Structural differences in the brain could contribute to someone having BPD. Researchers who have conducted brain scans on people with BPD have noticed differences in structures of the brain linked to emotions and impulsivity. 

What conditions commonly co-occur with borderline personality disorder?

It is very common for someone with BPD to have one or more co-occurring mental health conditions on top of their BPD. For example, it’s estimated that anywhere from 80% to 96% of people with BPD have a mood disorder, and around 88% have an anxiety disorder.

Some examples of common BPD mental health comorbidities are:

• Major depressive disorder
• Bipolar disorder
• Anxiety disorders
• Substance use disorder
• Eating disorders
• Attention deficit hyperactivity disorder (ADHD)
• Post-traumatic stress disorder (PTSD)

What is the treatment for quiet borderline personality disorder?

Living with personality disorders like BPD can be very hard, especially if the mental health condition goes left untreated. However, getting support for BPD from a mental health professional can change your life. BPD treatment typically involves psychotherapy (also known as talk therapy) and medication. Here’s an overview of common treatment options.

Therapy for BPD

One of the most common therapies used to treat BPD is dialectical behavior therapy (DBT), which was designed specifically for this purpose. Douglass says some of the main goals of DBT are to learn how to regulate emotions, stop self-destructive behavior (like self-harm), and have healthier relationships. For example, you’ll learn important tools to cope with intense emotions in a healthy way rather than in a dangerous or self-destructive way.

DBT includes a mix of individual therapy, skills training, and group therapy sessions. In these sessions, you will learn to manage your symptoms by using mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness (which focuses on building healthy interpersonal relationships).

Cognitive behavioral therapy (CBT) is another commonly used therapy for BPD treatment. Douglass notes CBT may be particularly helpful for people with quiet BPD who tend to be consumed by negative self-talk. CBT helps you identify negative, unhealthy thought patterns and replace them with healthier thoughts, leading to healthier behaviors and positive emotions. This will ultimately foster better mental health. You can also work on building a stronger sense of self and self-esteem in CBT. 

Other types of therapy for BPD include: 

• Mentalization-based therapy (MBT)
• Schema therapy (ST)
• Transference-focused therapy (TFP)
• Systems training for emotional predictability and problem-solving (STEPPS)

Medication for BPD

When considering medication for BPD, it’s important to note that there is no medication specifically for BPD, Douglass says. No drug is FDA-approved for BPD treatment. However, medication is often prescribed to help people manage some symptoms that come along with BPD, says Douglass. 

Commonly prescribed medications are:

• Antidepressants: Antidepressants, specifically (primarily SSRIs and SNRIs), are used to treat anxiety and depressed mood symptoms.
• Mood stabilizers: Mood stabilizers can help level out mood. They can also reduce the frequency and severity of mood swings and impulsivity. 
• Antipsychotics: Although these meds are originally intended for treating psychosis, they can also address aggression, anxiety, impulsivity, delusions, or hallucinations in BPD. 

Additionally, in cases where there is a comorbid disorder, treating the symptoms of that disorder with medication can help improve someone’s overall mental health. A psychiatrist will discuss treatment options and determine what is best for you. A combination of therapy and medication is the most effective treatment plan for most people. 

Helping someone cope with quiet BPD

Are you reading this because you believe a loved one might have quiet BPD? If so, there are a few things you can do to help the teen or young adult in your life on their mental health journey. 

Educate yourself

Read up on the signs and symptoms of quiet borderline personality disorder so you can understand what your loved one is dealing with. You might not have firsthand experience feeling that way, but by learning more, you can try to understand why they feel or act the way they do. 

Let them know you care

Speak to your loved one and let them know their feelings and emotions matter and that you want to be there to support them. Validate that you care about them and want to help them on their mental health journey however you can. Urge them to have open, honest conversations with you rather than isolating or giving you the silent treatment. 

Encourage them to get help

If your loved one is not currently in therapy, and it’s clear that they’re struggling, have an honest conversation with them. If you can, let them know that you can help them look into treatment options or even offer to accompany them to a first visit. Getting support for borderline personality disorder can greatly improve their quality of life.

Take action in times of crisis

Many individuals may engage in impulsive BPD symptoms(such as engaging in risky sex, spending sprees, or reckless driving) or do other things to harm themselves. While you can’t control their behavior, you can try to intervene or encourage them to act in healthier ways. Additionally, in crisis mod, if they are threatening suicide, call 988.  

How Charlie Health can help 

If you or a loved one is struggling with quiet borderline personality disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for young people and families dealing with serious mental health conditions, including BPD and co-occurring mental health conditions. Our clinicians use evidence-based therapy modalities in online therapy sessions, consisting of individual therapy, group sessions, and family therapy. With guidance from experienced therapists and the social support of peers, you can start feeling better. Fill out the form below or give us a call to start healing today.